Anatomical intrabuccal respiratory mouthpiece

ABSTRACT

Anatomical intrabuccal respiratory mouthpiece in two parts, namely: 
     a first extraoral part (1) having a first extrabuccal connection piece (2) intended to be joined to the gas source, and a second intrabuccal connection piece (5) whose outlet orifice is oblate (6); 
     a second part (10) forming a flexible orthesis, associated with the intrabuccal connection piece (5), including: 
     vertical vestibules (11, 12) matching the anatomical shape of the vestibules, being the upper (11) and lower (12) vestibules, respectively; 
     upper (25) and lower (26) vertical lingual rims, respectively; 
     a plane interocclusal vestibulo-lingual pad (20) which joins the vestibules (11, 12) and the rims (25, 26) and is arranged horizontally at the junction between the upper and lower parts, the thickness of said plane pad (20) being slightly greater than that of the interocclusal gap of the jaws in the rest position; 
     characterized: 
     in that the oblate intrabuccal (5) outlet orifice (6) opens out within the thickness of the vestibulo-lingual pad (20); 
     and in that the upper vestibular part (11) arranged in the anteroposterior direction is situated in front of the lower vestibular part (12).

TECHNICAL FIELD

The invention concerns an anatomical intrabuccal respiratory mouthpiece;it relates more particularly to an anatomical respiratory mouthpiece formedical usage, for example for patients "suffering from respiratoryinsufficiency", that is to say patients who can no longer spontaneouslyventilate, permanently or temporarily, whatever the cause, such aspatients suffering from myopathy, tuberculosis, or else for treatments,by medicinal or nonmedicinal aerosols, of contagious diseases (HIVpositive, etc.). It also concerns a respiratory mouthpiece for skindiving.

In the rest of the description, the invention will be described moreparticularly in its medical application.

STATE OF THE ART

To assist ventilation in those with respiratory insufficiency, aflattened conical device is in most cases inserted into their mouths,said device having, at one end, a first circular extrabuccal connectionpiece intended to be joined to the source of oxygen-enriched air, and asecond intrabuccal connection piece whose outlet orifice is oblate andhas a slight rim so that it can be held by the patient's teeth. Althoughvery widely used, this device has many disadvantages, namely, inparticular:

lack of stability in the mouth,

lack of tightness,

inadvertent expulsions by the patient, especially during the night orduring insufflation of air, said disadvantages necessitating an almostpermanent monitoring of these patients.

To remedy these disadvantages, one might have considered equipping theintrabuccal end of this device with an appropriate orthesis.Unfortunately, this is not practicable, since the casting of the upperand lower maxillae, respectively, and mandibles, and the recording ofthe occlusion, are unfortunately not possible in view of the veryserious condition of these patients.

Thus, despite the disadvantages mentioned hereinabove, the technique ofthe flattened device continues to be widely used.

In extreme cases, if this technique is not tolerated, or is rejected, itis necessary to proceed either with nasal intubations or withtracheotomy.

The document UK-A-699,950 describes a respiratory mouthpiece forpatients who are to be subjected to electric shock treatment, saiddevice including a molded part receiving the two jaws and intended tokeep them apart. This device intended for a specific use (electricshocks) has a rigid tube which enters the mouth and covers a large partof the tongue, which causes considerable inconvenience. Moreover, itnecessitates a mandibular overhang and cannot therefore be worn withcomfort for a long period of time.

DESCRIPTION OF THE INVENTION

The invention overcomes these disadvantages. Its object is anintrabuccal respiratory device, in particular for patients requiringrespiratory assistance, which is easy to manufacture, economical, doesnot have the disadvantages listed hereinabove, and can be put into placevery easily, without having to take impressions or the like beforehand,irrespective of the condition or the configuration of the patient.

This anatomical intrabuccal respiratory mouthpiece which comprises twoparts, namely:

a first extrabuccal part having a first extrabuccal connection pieceintended to be joined to the gas source, and a second intrabuccalconnection piece whose outlet orifice is oblate;

a second part forming a flexible orthesis, associated with theintrabuccal connection piece, including:

vertical vestibules matching the anatomical shape of the vestibules,being the upper and lower vestibules, respectively;

upper and lower vertical lingual rims, respectively;

a plane interocclusal vestibulo-lingual pad which joins the vestibulesand the rims and is arranged horizontally at the junction between theupper and lower parts, the thickness of said plane pad being slightlygreater than that of the interocclusal gap of the jaws in the restposition;

is characterized:

in that the oblate intrabuccal outlet orifice opens out within thethickness of the vestibulo-lingual pad;

and in that the upper vestibular part arranged in the anteroposteriordirection is situated in front of the lower vestibular part.

In other words, in the case of a respiratory mouthpiece of the type inquestion, the invention consists, on the one hand, in providing aflexible orthesis with vertical vestibules and vertical lingual rimswhich are joined via a plane horizontal pad, and the implantation of thevestibules taking into consideration the average mandibular position inrelation to the maxilla so as to avoid forward sliding of the mandible,and thereby to improve comfort, and, on the other hand, in ensuring thatthe oblate intrabuccal outlet orifice opens out into the plane pad so asnot to cause any obstruction in the area of the tongue.

In this way, a standard device is afforded which is able to take accountof the morphology of each patient and which can therefore be usedimmediately and effectively on any type of patient requiring respiratoryassistance, irrespective of the cause.

Advantageously, in practice:

the oblate intrabuccal outlet orifice opens out in the front part orlateral parts, or even posterior parts, of the vestibulo-lingual pad;

the distance between the two upper and lower vestibular parts is of theorder of two to four millimeters, advantageously in the region of threemillimeters;

the thickness of the vertical vestibules decreases from the base,connecting with the pad, to their upper end; in one practicalembodiment, the thickness of the vertical vestibules is approximatelytwo millimeters at the base and one millimeter at the free end;

the free contour of the upper vestibule matches the contour of thebridles and frenula of the upper jaw; in this way, it is simple, with apair of scissors, to modify this contour in the case where thevestibules are shallow or the frenula hypertrophic;

the thickness of the pads varies from three to four millimeters, and thewidth of the plane of the vestibulo-lingual portion is between ten andfifteen millimeters, depending on the model, in such a way as to beslightly greater than the thickness of the teeth; in this way, it iseasy to make several models, in one of which the pads have a width ofapproximately ten millimeters, another with a mean width of twelvemillimeters, and another with a width greater than fifteen millimeters;

the lingual rims have a thickness which diminishes gradually startingfrom the joining portion, for example from 2 to 1.5 mm;

the vestibules and the rims end substantially in the area of the secondpremolars;

the first extraoral part forms an angle of 15 to 30⁻, preferably in theregion of 20⁻, in relation to the occlusion plane; this inclination hasthe advantage of ensuring that the pipe connecting the source of gas,for example air, to the extrabuccal connection piece does not pointvertically upward when the patient is lying; thus, this pipe system isless vulnerable;

the orthesis is made of biocompatible and flexible thermoplasticmaterial which is thermoformable, especially at the body temperature inthe mouth area, in such a way that this intrabuccal orthesis adaptsitself quickly and progressively to the actual buccal volume of thepatient, or even rapidly by immersion in hot water (45° C.-50° C.);strongly plasticized, but uncharged, polyvinyl chloride (PVC) is used,for example, to achieve great pliability, or any other material havingthe same physical characteristics.

The manner in which the invention can be realized and the advantageswhich derive therefrom will become more apparent from the illustrativeembodiment which follows, supported by the attached figures.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a general perspective representation, in a three-quarter viewfrom the front, of a respiratory mouthpiece in accordance with theinvention.

FIG. 2 is a plan view of this mouthpiece, in horizontal longitudinalsection in FIG. 3.

FIG. 3 is a horizontal section of FIG. 2.

FIG. 4 is a detailed view of the connection of the first extraoral partto the second part.

FIG. 5 is a general perspective representation, in a three-quarter viewfrom the rear, of another embodiment of the invention, shown in a rearview in FIG. 6.

FIG. 6 is a rearview of FIG. 5.

MANNER OF REALIZING THE INVENTION

Referring to the figures, the anatomical intrabuccal respiratorymouthpiece in accordance with the invention essentially comprises twoparts which are made integral with each other, for example cast en blocor heat-sealed, namely a first part designated by the general reference(1) and a second part designated by the general reference (10),respectively. It goes without saying that these two main parts canthemselves be made up of a number of secondary parts.

The first extraoral part (1), which is known in other respects, andwhich, corresponding to the prior art, comprises a first extrabuccalcylindrical connection piece (2) intended to be joined to the source ofgas, for example oxygen-enriched air, then a body (3) in the shape of aflattened truncated pyramid joined to the connection piece (2) via atruncated portion (4). This body (3) finishes in a second intrabuccalconnection piece (5) whose outlet orifice (6) is oblate, for example hasa rectangular cross section of twenty millimeters by two millimeters.

The first part of the mouthpiece (1) is associated with a second part(10) forming a flexible orthesis, for example made of stronglyplasticized PVC. This second part (10) in the first instance comprisestwo vertical vestibules, upper (11) and lower (12), respectively, whoseshape matches the anatomical shape of the vestibules.

In one practical embodiment, the base (13, 14) connecting thesevestibules (11, 12) to the intrabuccal outlet orifice (5, 6) has athickness near to two millimeters, whereas the free end (15, 16) has athickness near to one millimeter.

The second part (10) also includes, arranged horizontally at thejunction of the upper (11) and lower (12) parts, a planevestibulo-lingual pad designated by the reference (20) in the shape of asmooth or even striated interocclusal horizontal platform joining thevestibules (11, 12) to the upper rim (25) and lower rim (26),respectively, of the two substantially vertical lingual rims (25, 26).

According to another important characteristic of the invention, thethickness of the horizontal plane pads (20) is slightly greater than theinterocclusal gap between the jaws in the rest position, which allowsfor a good hold in the mouth, without any strain and without musclecontraction, the teeth resting on the pads (20).

Likewise, according to one important characteristic of the invention,the oblate (6) intrabuccal (5) outlet orifice opens out within thethickness of the vestibulo-lingual pad (20) (see FIG. 4).

In one variant, the mouthpiece of the invention can also be used incases of substantial prognathism by reversing it and cutting itappropriately.

It can also be used in an emergency situation in order to provoke theprotrusion of the mandible in such a way as to free the airways.

In another variant, which is shown in FIG. 5, the intraocclusal pads(20) are connected to each other by a small, horizontal and slightlycurved flap (30) intended to immobilize the tongue so as to avoid therisk of obturating the buccopharyngeal orifice.

The device according to the invention has many advantages compared tothose marketed at present and cited in the preamble. The following maybe mentioned:

the possibility of making a limited number of models by virtue of astandard device, for example small, medium and large models, or evenneonatal models, without having to take impressions, which, as is known,are impossible to obtain from these patients;

the possibility of having at one's disposal devices which can be usedimmediately, in particular in patients suffering attacks;

inherent adaptability to the buccal volume of the patient;

good stability in the mouth, avoiding accidental loss, particularlyduring sleep or during a coma;

excellent tightness;

no inadvertent expulsion;

the fact that the patient does not have to make any effort to keep thedevice in the mouth;

the ease with which the contour can be modified in order to adapt betterto the morphology of the patient.

In this way, this device can be used successfully for all types ofmedical respiratory insufficiency, particularly when a disposable deviceis sought.

It can also be used on completely or partially edentulous patients.

This device can also be used successfully for mouthpieces forskindiving, since it prevents forward sliding of the mandible, which inthe long term generates pain in the temporomandibular joint. In thisapplication, the extraoral part (1) can be connected directly to thepressure regulator or to the surface breathing tube, commonly called"snorkel".

I claim:
 1. An anatomical intrabuccal respiratory mouthpiece in twosections that includes:a first extraoral section having an extrabuccalconnection piece that is connectable to a gas source and an intrabuccalconnection piece having an oblate outlet orifice, a second sectionforming a flexible orthesis associated with said intrabuccal connection,said second section further including:two vertical vestibules matchingan anatomical shape of the vestibules, said vertical vestibulesconsisting of an upper and a lower vestibule, upper and lower verticallingual rims, and an interocclusal vestibulo-lingual plane pad whichjoins the vestibules and the rims and is arranged horizontally at ajunction between the upper and lower vestibules, a thickness of saidvestibulo-lingual plane pad being slightly greater than that of aninterocclusal gap of upper and lower jaws therein when said jaws are ina rest position, said second section is made of biocompatible andflexible thermoplastic material which is thermoformable at standard bodytemperature in a mouth area; said outlet orifice of said intrabuccalconnection piece opens outwardly within the thickness of thevestibulo-lingual plane pad, and said upper vestibule being arranged inan antero-posterior direction is situated in front of the lowervestibule.
 2. Respiratory mouthpiece according to claim 1, wherein theoblate outlet orifice opens out at a front, or in a lateral or posteriorpart, of the vestibulo-lingual plane pad.
 3. Respiratory mouthpieceaccording to claim 2, wherein a distance between the upper and lowervestibules is between two and four millimeters.
 4. Respiratorymouthpiece according to claim 3, wherein a thickness of the vestibulesdecreases from a base, connected with the pad, toward an opposite endthereof.
 5. Respiratory mouthpiece according to claim 4 wherein theupper vestibule has a free contour that matches a contour of bridles andfrenula of the upper jaw.
 6. Respiratory mouthpiece according to claim 5wherein the thickness of the horizontal vestibulo-lingual pad is betweenthree and four millimeters, and a width of the pad is between ten andfifteen millimeters.
 7. Respiratory mouthpiece according to claim 6, thefirst extraoral section forms an angle of 15° to 30° in relation to anocclusion plane.
 8. Respiratory mouthpiece according to claim 7 whereinthe second section is made of biocompatible and flexible thermoplasticmaterial which is thermoformable at the body temperature in the moutharea.